progressive damage

A few of us in the main conference room: the new foundation person, the executive director, development, program leads. Meet and greet for the new foundation person.

We have a telescope that we point out the window by way of show and tell, magnifying different parts of the South Bronx for the new foundation person. The practice people zone in close on an old tan brick. Much to say re> brick, much that can be changed. Is the change sustainable?

The policy folks aim the telescope at the sky. There isn't much, I think a cloud, I think maybe a flit of a hawk or a daring high-altitude pigeon, sunlight diffuse and un-pinpointable. Sunlight, if only you could get to the source and change the angle or tint. If only you could start upstream.

The foundation person turns the telescope back into the room and inspects the angles where the walls meet the floor, the ceiling. An hour passes, during which she asks a sequence of architectural questions, ranging catholic from arcane to obvious to questions put in terms we understand, but devastatingly difficult to answer. From her tone at first (world weary disappointment and smartest guy in the room and vague hint of should have stayed asleep today) it's hard to tell but I think we're doing alright.

Beat. Beat. Someone from our side asks, "But how can we fix all this?" Gesturing out the window, out at the world at large, out into the world as it is.

"Good question," the new foundation person admits. For a second it looks like her face is going to sag off of its moorings, that she might lose corporeal stature, her spirit spilling onto the floor.

She gathers her thoughts and answers sharply, answers in herobureacratic fashion, for a minute we can all picture the solution. We break for lunch.

reform committee

One additional suggestion for federal health policy reform efforts: to ensure that these efforts are successful, the government ought to establish a ten-year committee to analyze the problem.

The committee will issue 2 reports at five-year intervals. It will be evenly bipartisan and should reflect the perspective of every stakeholder (doctor, nurse, worker, consumer, for-profit business owner, administrator, policymaker, family member, etc.)

The first five year report will serve as a Mid-Term Report, and provide hints about the contours of the second, final report. The Final Report may also recommend an additional ten-year period, which could itself be extended. Each report should be drafted by the same unpaid intern.

Questions to be addressed include: What is every possible angle on the problem? Is there a problem? Is a solution necessary? If it will always be broke, should we fix it?

health reform that works

America spends far more on health care than other industrialized nations, yet lags persistently behind in health outcomes. With quality widely considered by experts to be a lost cause, successful health reform will focus exclusively on cutting costs, killing the poor, and maximizing profit for doctors and private industry.

In that spirit, a 13-point plan to destroy America's health care system:

1. Require doctors and all care providers to adopt a Patriot version of the Hippocratic Oath on which unanimous bipartisan agreement has be reached.

2. Ensure that the public makes informed decisions about pharmaceuticals, by requiring medical journals and scientific trials to operate under the full editorial control of the drug companies that produce them. Disallow the sale and manufacture of a given pharmaceutical when its patent expires after 7 years, requiring replacement with new brands. Outlaw generics and the export of drugs to the developing world.

3. Create Altria Wellness Centers in communities and schools, promoting Kraft and Phillip Morris products to remedy common ailments.

4. Require a license for exercising more than 10 minutes per day, to be maintained by unsubsidized weekly fees, and policed by randomized steroid, human growth hormone, and drug testing. Disallow exercise for high risk patients.

5. Increase the use of paper records; where possible incorporate scrap paper. Prescriptions should be written in crayon, or using human feces and an improvised wooden utensil.

6. Health reform needs a public option: an option for the public to purchase private insurance at inflated prices. Eliminate Medicaid, Medicare, and CHIP.

7. Require drug and device manufacturers to provide payments and incentives to providers and physicians, with a zero tolerance policy regarding transparency.

8. Strengthen existing incentives for tests and procedures; eliminate all documentation of primary care outcomes.

9. Increase the prevalence of C-sections, reduce the use of doulas, and eliminate the education of women about the risks and benefits of obstetric procedures. Create special, more lenient laws concerning the murder of abortion providers.

10. The number of uninsured Americans under 65 has increased more than 10 million since 1999, or an increase of little more than 1 million per year. Increase premium costs and coverage restrictions to magnify this trend and further reduce costs.

11. Appoint Princeton University's Peter Singer as Czar for Life of the U.S. Department of Health and Human Services, giving him broad discretion on policy decisions.

12. Close all free clinics, and require insurance coverage for care in all provider settings. Enact legislation banning the un-insured and under-insured from stepping within 500 feet of all provider settings.

13. Bomb France. And Cuba. And Scandinavia as a whole. More wars = more patients.

(For SE.)